Removal (via snare/capture) and Replacement of Internally Dwelling Ureteral Stent via Transurethral Approach, without Use of Cystoscopy, Including Radiological Supervision and Interpretation

Name of the Procedure:

• Common Name: Ureteral Stent Replacement
• Medical Term: Transurethral Ureteral Stent Removal and Replacement without Cystoscopy

Summary

This procedure involves the removal and replacement of a ureteral stent through the urethra using a snare or capture technique, without the aid of cystoscopy. It includes radiological supervision and interpretation to guide and confirm the correct positioning of the new stent.

Purpose

• Medical Condition: Blockage or narrowing of the ureter, kidney stones, or other obstructions.
• Goals: To ensure proper urine flow from the kidney to the bladder, relieve pain, and prevent kidney damage.

Indications

• Symptoms: Severe flank pain, frequent urinary tract infections (UTIs), reduced kidney function, or difficulties with urination.
• Patient Criteria: Individuals with existing ureteral stents needing replacement, patients with confirmed ureteral obstructions.

Preparation

• Pre-procedure Instructions: Patients may need to fast for several hours. Adjustments to medications (such as blood thinners) may be necessary.
• Diagnostic Tests: Preliminary imaging studies like ultrasounds or CT scans to assess the position and condition of the current stent.

Procedure Description

1. The procedure is performed under appropriate anesthesia to ensure patient comfort.
2. A snare or capture device is inserted through the urethra to locate and retrieve the existing stent.
3. Using radiological guidance, the old stent is carefully removed.
4. A new stent is then introduced and positioned correctly with continuous radiological monitoring to ensure proper placement.
5. The procedure is completed without the use of a cystoscope.

Duration

• Typically takes around 30 minutes to one hour.

Setting

• Usually performed in a hospital setting, outpatient clinic, or surgical center with radiological facilities.

Personnel

• Urologist or specialized surgeon
• Radiologist
• Nurses
• Anesthesiologist (if sedation or anesthesia is used)

Risks and Complications

• Common Risks: Bleeding, infection, discomfort during the procedure.
• Rare Risks: Ureteral injury, improper stent placement, need for additional procedures.

Benefits

• Relief from kidney pain and discomfort.
• Restoration and maintenance of normal urine flow.
• Benefits are often realized immediately after the procedure.

Recovery

• Post-procedure Care: Hydration, monitoring for signs of infection, and managing pain as needed.
• Recovery Time: Typically brief, with most patients resuming normal activities within a few days.
• Follow-up: Periodic imaging studies to ensure the stent remains correctly positioned.

Alternatives

• Other Options: Open surgical stent placement, cystoscopy-guided stent replacement.
• Pros and Cons: Alternatives may be more invasive or better suited for complex cases.

Patient Experience

• During the Procedure: Minimal discomfort due to anesthesia or sedation.
• After the Procedure: Mild urinary discomfort and possible blood-tinged urine for a few days.
• Pain Management: Over-the-counter pain relievers and prescribed medications as needed.

This comprehensive overview aims to ensure patients are well-informed about the ureteral stent replacement procedure and what to expect before, during, and after treatment.